Should low-molecular-weight heparin be used in the treatment of acute coronary syndromes in rural hospitals?

Objective — To evaluate the use of low-molecular-weight heparin (LMWH) for acute coronary syndromes (ACS) in a rural setting.

Methods — A review of LMWH effectiveness and a simplified costing exercise that focused on potential differences between rural and urban settings for delivering LMWH versus unfractionated heparin (UFH).

Results — LMWH is as clinically effective as UFH for the treatment of ACS in a rural setting. The estimated drug delivery cost of the dalteparin ($65 per admission) was less than that for UFH ($110). The high cost of after-hours activated partial thromboplastin time monitoring in a rural setting ($86 per admission) more than offset the increased cost of LMWH compared to UFH.

Conclusions — LMWH is the heparin of choice for the treatment of ACS in a rural setting. The method of using an abbreviated effectiveness and costing exercise may be a practical approach for evaluating other health interventions in a rural setting.